The presence of arthrosis after operation for terrible triad injuries was 11.2% [39] in comparison to 36% in a separate study of non-operative treatment [28]. USA.gov. The terrible triad of the elbow is a severe elbow fracture-dislocation pattern and is so-called because it has poor medium-to-long term outcome.. There is no unifying classification system for complex dislocations or terrible triad injury. J Shoulder Elbow Surg 2015; 24(3): 333-8. Bucholz, J.D. The elbow is the second most commonly dislocated joint in adults and up to 20% of dislocations are associated with a fracture. J Orthop Trauma 2000; 14(5): 354-8. These complex trans-olecranon fracture dislocations are relatively uncommon [50]. Radial head reconstruction versus replacement in the treatment of terrible triad injuries of the elbow. 2 Mathew PK, Athwal GS, King GJ. They provide easy access to the latest research on a wide variety of issues. Where there is no other fracture and the dislocation is reduced, the treatment should focus less on the function as a stabiliser and more on the function of the radial head in forearm supination and pronation and the prevention of arthrosis [16, 17]. Heterotopic ossification formation after fracture-dislocations of the elbow. Following radial head replacement or ORIF the LCL should be repaired to the lateral condyle using suture anchors or transosseous sutures (Figs. Open Orthop J 2010; 4: 80-6. 1979;61(1):63-68. These are high energy injuries often caused by road traffic collisions [51, 52] and are associated with concomitant ipsilateral elbow injuries, such as segmental fracture in over 80% [53]. These cases are uncommon, but remind us that elbow fracture dislocations and terrible triad injuries are often high-energy, and patients often have concomitant fractures or soft tissue injuries in the ipsilateral limb that may delay recovery if missed. van Riet RP, Morrey BF, O’Driscoll SW. Use of osteochondral bone graft in coronoid fractures. Lindenhovius AL, Jupiter JB, Ring D. Comparison of acute versus subacute treatment of terrible triad injuries of the elbow. J Hand Surg Am. ", "Open access journals represent a major break-through in publishing. Surgical technique. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. 2009 Mar;17(3):137-51. doi: 10.5435/00124635-200903000-00003. Clin Orthop Relat Res 1980; (146): 42-52. The radiohumeral articulation is a secondary stabiliser, providing up to 30% of lateral and anterior stability throughout the flexion arc [10, 11]. Usual technique is shown in Fig. Whereas the importance of early recognition of neurovascular compromise is well described and nearly universally recognized, the importance of timely and correct treatment in preventing delayed complications and potential instability is often less emphasized in the radiology literature. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals. Cases J 2008; 1(1): 168. The stabilizers of the elbow are disrupted from lateral to medial as the forearm supinates and is loaded [23]. Fracture of the anteromedial facet of the coronoid process. Chemama B, Bonnevialle N, Peter O, Mansat P, Bonnevialle P. Terrible triad injury of the elbow: How to improve outcomes? Traumatic forearm and elbow injuries make up approximately 15% of emergency department visits for upper-extremity musculoskeletal injuries annually (1). 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